Optimizing Self-Monitoring in a Digital Weight Loss Intervention (Spark): Protocol for a Factorial Randomized Trial

Abstract

Background: Self-monitoring is a vital component of behavioral obesity treatment. It often involves tracking dietary intake, physical activity, and body weight. However, the optimal combination of self-monitoring strategies that maximizes weight loss is unknown. To address this gap, we leverage a framework called the multiphase optimization strategy, which facilitates the identification of an intervention's "active ingredients" that promote weight loss and its "inactive ingredients" that have little impact, thus adding unnecessary patient effort and time demands.

Objective: This study aims to examine the unique and combined weight loss effects of 3 popular self-monitoring strategies (tracking dietary intake, steps, and body weight).

Methods: Spark was an optimization-randomized clinical trial that used a 2 × 2 × 2 full factorial design with 8 experimental conditions. Participants, US adults with overweight or obesity (N=176), were randomized to receive 0-3 self-monitoring strategies in a 6-month fully digital weight loss intervention. For each assigned strategy, participants were instructed to self-monitor daily via commercially available digital tools (a mobile app, wearable activity tracker, and smart scale) and received a corresponding goal (eg, a daily calorie goal) and weekly automated feedback. All participants received core intervention components, including weekly lessons and action plans informed by Social Cognitive Theory, to promote healthy eating and physical activity. Assessments occurred at baseline and at 1, 3, and 6 months. Weight was assessed objectively via a smart scale. The primary aim is to test the main effects of the 3 self-monitoring components and their interactions on weight change from baseline to 6 months. Secondary outcomes include change in BMI, caloric intake, diet quality, physical activity, and health-related quality of life, as well as 1- and 3-month weight change and the relation between self-monitoring engagement and weight change. Patterns of engagement will be operationalized as the percentage of days of self-monitoring during the 6-month intervention. Moderators of weight loss success will be explored to understand whether certain subgroups of individuals benefit more from specific self-monitoring strategies. We also conducted a separate embedded experiment to test the impact of a self-directed web-based orientation session on 6-month trial retention. After the intervention, semistructured qualitative interviews were conducted with a subset of participants to elucidate factors that impact engagement and its link to weight loss.

Results: Recruitment occurred from September 2023 to November 2024. Data collection was completed in June 2025. Data analysis is ongoing.

Conclusions: This trial will provide evidence as to which self-monitoring strategies are the "active ingredients" in a fully digital weight loss intervention and begin to explore which subgroups may do best with which strategies. These results have potential for public health impact by maximizing weight loss while minimizing patient burden.

Trial registration: ClinicalTrials.gov NCT05249465, https://clinicaltrials.gov/study/NCT05249465.

International registered report identifier (irrid): DERR1-10.2196/75629.

Keywords: RCT; behavior change; behavioral obesity treatment; digital health; intervention; multiphase optimization strategy; obesity; randomized controlled trial; self-monitoring; tracking; weight loss.